Anaphylaxis and Mast Cell Disorders
Open accessAbstract
There is strong evidence of an association between severe anaphylaxis, especially hymenoptera venom induced, and mast cell (MC) disorders. It has been thought that intrinsic abnormalities in MCs, including the presence of the activating KIT D816V mutation in mastocytosis or of genetic trait, hereditary alpha-tryptasemia, may influence susceptibility to severe anaphylaxis. This article evaluates the potential mechanisms leading to severe MC activation, as well as the differential diagnosis of and range of symptoms attributable to MC mediator release. Also, we offer a global classification for disorders related to MC activation.
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There is a consensus that HαT is a risk modifier of severe anaphylaxis.
“There is a consensus that HαT is a risk modifier of severe anaphylaxis [21,48,49,50,51,52,53].”
From Diagnostic Significance of Tryptase for Suspected Mast Cell Disorders (2023) · cites this paper as [50]
The Hereditary Alpha-Tryptasemia section describes HαT as a modifying factor and reports an increased risk of severe anaphylaxis. But it says HαT *may* confer that risk and that the findings need confirmation in larger cohorts; it does not establish the claimed consensus. (LLM, conf=0.84)
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Valent, P., Hartmann, K., Bonadonna, P., Gülen, T., Brockow, K., Alvarez-Twose, I., Hermine, O., Niedoszytko, M., Carter, M. C., Hoermann, G., et al. (2022) · The Journal of Allergy and Clinical Immunology: In Practice · doi:10.1016/j.jaip.2022.05.007 · Cited by 90 · see citing works
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Self-citationMast cell activation syndromes: Collegium Internationale Allergologicum update 2022
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Epidemiology of mastocytosis: a population-based study (Sweden)
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Biological Effects of Animal Venoms on the Human Immune System
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Pyatilova, P., Akin, C., Alvarez-Twose, I., Arock, M., Bonadonna, P., Brockow, K., Butterfield, J. H., Broesby-Olsen, S., Carter, M. C., Castells, M., et al. (2022) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2022.05.037 · Cited by 27 · see citing works
Self-citationDrug-induced mast cell eradication: A novel approach to treat mast cell activation disorders?
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Self-citationAcute Urticaria and Anaphylaxis: Differences and Similarities in Clinical Management
Ensina, L. F., Min, T. K., Félix, M. M. R., de Alcântara, C. T., & Costa, C. (2022) · Frontiers in Allergy · doi:10.3389/falgy.2022.840999 · Cited by 26 · see citing works
Bonadonna, P., Olivieri, F., Jarkvist, J., Nalin, F., Zanotti, R., Maclachlan, L., & Gülen, T. (2022) · Frontiers in Allergy · doi:10.3389/falgy.2022.1071807 · Cited by 25 · see citing works
Self-citationZaghmout, T., Maclachlan, L., Bedi, N., & Gülen, T. (2024) · The Journal of Allergy and Clinical Immunology: In Practice · doi:10.1016/j.jaip.2023.11.041 · Cited by 23 · see citing works
Self-citationA Puzzling Mast Cell Trilogy: Anaphylaxis, MCAS, and Mastocytosis
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Self-citationDiagnostic Significance of Tryptase for Suspected Mast Cell Disorders
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Self-citationUsing the Right Criteria for MCAS
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Self-citationDisease Spectrum of Anaphylaxis Disorders
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Self-citationCurrent and future therapeutics targeting mast cells in disease
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Self-citationDrug-Induced Anaphylaxis Uncommon in Mastocytosis: Findings From Two Large Cohorts
Beyens, M. M. J., Sabato, V., Ebo, D. G., Zaghmout, T., & Gülen, T. (2024) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2024.03.040 · Cited by 15 · see citing works
Self-citationPerioperative anaphylaxis to fibrin sealants in children with Noonan Syndrome
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Management of Mediator Symptoms, Allergy, and Anaphylaxis in Mastocytosis
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Self-citationDiagnosis and Management of Patients With Mast Cell Activation Syndromes: Status 2026
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Self-citationJarkvist, J., & Gülen, T. (2023) · Diagnostics · doi:10.3390/diagnostics13132241 · Cited by 11 · see citing works
Self-citationAnaphylaxis: Advances in the Past 10 Years
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Defining hereditary alpha-tryptasemia as a risk/modifying factor for anaphylaxis: Are we there yet?
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Mast cell activators as adjuvants for intranasal mucosal vaccines
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Broi, U. D., Simonit, F., Perogio, M., Visentini, D., Reccardini, F., Tse, R. D., Garland, J., Ondruschka, B., & Desinan, L. (2025) · International Journal of Legal Medicine · doi:10.1007/s00414-025-03487-1 · Cited by 3 · see citing works
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İğde, M. H., Korkmaz, P., Toprak, İ. D., Karabacak, D. E., Demir, S., Ünal, D., & Gelincik, A. A. (2025) · Allergy and Asthma Proceedings · doi:10.2500/aap.2025.46.250025 · Cited by 3 · see citing works
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Rijavec, M., Kogovšek, Ž., Inkret, J., Kopač, P., Košnik, M., & Korošec, P. (2026) · Clinical & Experimental Allergy · doi:10.1111/cea.70227 · Cited by 2 · see citing works
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Rudenko, M. (2022) · EMJ Allergy & Immunology · doi:10.33590/emjallergyimmunol/10144966 · Cited by 2 · see citing works
Mast cell activation syndrome: The overdiagnosis problems
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Heuser, W., Frieri, M., Kumar, K., & Boutin, A. (2015) · American Journal of Immunology · doi:10.3844/ajisp.2015.116.124
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Khokhar, D. S., & Akin, C. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-96018-2.00007-9
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Pouessel, G. (2023) · Revue française d'allergologie · doi:10.1016/j.reval.2023.103670
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Lactate in Anaphylaxis: 100 Years On
Borzova, E. Y., & Gibbs, B. F. (2025) · Sports Medicine · doi:10.1007/s40279-025-02273-8
Bergström, A., Hägglund, H., Berglund, A., Nilsson, G. P., & Lambe, M. P. (2025) · Acta Dermato Venereologica · doi:10.2340/actadv.v105.43052
The role of tryptase in the human body: From normal to pathology
Lisiecka, M. Z. (2025) · Medicinski casopis · doi:10.5937/mckg59-55869
Hereditary Alpha-Tryptasemia and Mastocytosis: What We Know and What We Need To Learn
Rama, T. A., & Gülen, T. (2026) · Current Allergy and Asthma Reports · doi:10.1007/s11882-026-01262-9 · Cited by 1 · see citing works
Self-citationJohnsson, A., Atanasoai, I., Nilsson, G. P., & Gülen, T. (2026) · Journal of Allergy and Clinical Immunology Global · doi:10.1016/j.jacig.2026.100699
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Gülen, T., & Sabato, V. (2026) · ImmunoTargets and Therapy · doi:10.2147/itt.s609692
Self-citationTian, J., Zhu, G., Qin, M., Jia, C., Ma, S., Wang, B., & Luo, Y. (2026) · Pediatric Investigation · doi:10.1002/ped4.70065
Huang, Y., Xu, S., Rong, P., Wang, D., & Lu, J. (2026) · Frontiers in Immunology · doi:10.3389/fimmu.2026.1905112
- Authors
- Gülen, T., & Akin, C.
- Affiliations
- Karolinska University Hospital (SE)
- University of Michigan (US)
- Corresponding author
- Gülen, Theo
- ORCID
- Venue
- Immunology and Allergy Clinics of North America
- Publisher
- Elsevier BV
- Published
- 2022-02
- Volume
- 42
- Issue
- 1
- Pages
- 45-63
- ISSN
- 0889-8561 (ISSN-L)
- OpenAlex
- W3215717282
- Cited by
- 51
- References
- 85
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 6 · 2023: 10 · 2022: 16 · 2015: 1
- FWCI
- 0.82
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Immunology and Allergy Clinics of North America (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Karolinska Institutet
- Stockholms Läns Landsting
- Topics
- Life Sciences › Immunology and Microbiology › Immunology › Mast cells and histamine
- Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
- Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
- Keywords
- anaphylaxis, mast cell disease, hymenoptera venom allergy, KIT D816V mutation, mastocytosis, hereditary alpha-tryptasemia, mast cell activation, mast cell mediator release, differential diagnosis
- MeSH terms
- Anaphylaxis, Arthropod Venoms, Humans, Mast Cells, Mastocytosis, Tryptases
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